HIV/AIDS strategic plan costed at $450M

Stabroek News
December 1, 2000

World AIDS Day is being observed today. In keeping with the occasion Stabroek News is continuing its Spotlight on this issue which began in yesterday's edition.

The three-year national strategic plan for STI/HIV/AIDS' thrust is to expand a coordinated response to the HIV/AIDS epidemic. The plan is comprehensive and embodies five major components to address the HIV/AIDS situation in the country: programme management; monitoring and evaluation; information, education and communication; care and support and special programmes. The overall financial resources needed to carry out these activities are estimated at $450 million. However, without human skills it would be difficult to undertake the task.

To operationalise the strategic plan, an implementation plan 2000-2002, just sanctioned by the National AIDS Programme Secretariat (NAPS) has been developed. It is expected to be circulated to all ten administrative regions of the country, where under the guidance of regional AIDS committees, regional stakeholders will elaborate their action plans.

Among the activities conducted by NAPS this year were:
* sensitisation workshops for 225 healthcare providers at the Georgetown Public Hospital;
* men's march to launch World AIDS Campaign for 2000;
* disc jockey (DJ) sensitisation workshop;
* workshop on labour laws and AIDS--looking at including AIDS in the Labour Laws;
* training of trainers workshop for work places on AIDS sensitisation;
* AIDS sensitisation in Region Ten;
* launching of cricket campaign--"Don't Be Bowled Out By AIDS";
* quality assurance and bio-safety training programme by resource persons from the Caribbean Epidemiology Centre (CAREC) - target groups were biochemists and laboratory staff from private and public hospitals;
* National AIDS Committee (NAC) monthly sensitisation sessions in Regions Three, Four, Five, Six and Ten.

The National AIDS Committee (NAC) was re-established as an independent, advisory committee to the minister of health with several sub-committees: information, education and communication; legal and ethical; care and support; network for regional AIDS committees (RAC), and fund raising. The Legal and Ethical Sub-committee carried out a process of consultation to produce the National AIDS policy approved by the National Assembly in 1998.

As part of the overall strategy to prevent and control STI/HIV/AIDS in Guyana, NAPS and CAREC-GTZ developed a programme targeting female commercial sex workers (FCSWs) to ascertain the levels of HIV and syphilis among FCSWs in Georgetown, and to assess their risk factors for HIV. The results of the study are not yet released, but a re-survey is currently being done and plans are under discussion for expansion to other regions.

Again, NAPS and the Caribbean Epidemiology Centre-German Agency for Technical Cooperation (CAREC-GTZ) have developed a programme to increase access to Voluntary Counselling and Testing (VCT) services as a key element in the National AIDS Strategy. This initiative will be executed in three phases, two of which have already been completed: consultation with key stakeholders in the regions, together with the development of VCT protocol and the selection and training of 43 counsellors. To date five sites have been piloted in Regions Five and Six, and they have since been reviewed in an effort to expand the process.

Draft AIDS prevention bill weak - GHRA

In 1997, the 50th anniversary of the Universal Declaration of Human Rights stipulated 12 international guidelines on HIV/AIDS and Human Rights, with everything from instituting a framework for action to enacting protective laws for persons living with HIV/AIDS, all responsibilities of individual states and the international community.

The Guyana Human Rights Association (GHRA) says it has been monitoring the HIV/AIDS situation in Guyana since 1990. In fact, GHRA had reported the following year "a dangerously high incidence of HIV positive inmates in the prison. Continued complacency by the Government, judiciary and the population at large, over sub-human conditions prevailing in the prison will result in a similar high incidence spreading to the general population".

The GHRA has meantime set aside the Draft AIDS Prevention and Control Bill, and Programme Coordinator for the body, Merle Mendonca said the proposed legislation was "weak" and "pure nonsense". She said the GHRA has refused to accept the bill "because there's very little which speaks to HIV/AIDS" as "it does not follow the [National] Policy [on HIV/AIDS in Guyana] and Ministry of Health guidelines."

She disclosed that her organisation is currently studying pieces of AIDS legislation from the Dominican Republic, Canada, The Philippines, South Africa and Malaysia. However, she noted that these countries are also encountering problems with their legislation because of the many emerging sensitivities on the subject of persons living with HIV/AIDS.

Mendonca represents the GHRA on the National AIDS Committee (NAC) which is an advisory body to the Ministry of Health. Its Chairman is appointed by the Minister of Health.

The NAC Chairman was Andre Sobryan who died recently. Mendonca said while it is necessary that a new Chairman be appointed quickly, she noted that not having the Director of Communicable Diseases in the Ministry be the Chairman is a "plus" for Minister Henry Jeffrey, as the Director used to Chair the Committee. Her suggestion for another Chairman to be recommended comes amid GHRA's need for "collaboration, coordination, surveillance, research, testing and funding."

For instance, she raised the concern about the country not having enough doctors on top of the virus, noting that there are doctors who might be dispensing HIV/AIDS drugs without clinical management because they are not trained on the side effects of the medication.

She also said that the average Guyanese doesn't even query doctors on the medication they receive. There are only about two to three doctors in the public sector who are qualified on the disease, Merle said, and ventured that she doubts whether the private sector has any.

On the subject of institutional capacity, Mendonca suggested that the donor community can assist in hiring such people as medical personnel and statisticians, and not just hold workshops on sensitisation. Granted that there is always scope for volunteers, she said permanent staff is needed in certain areas. As for drafting legislation, Mendonca said there are only about one or two legal draftsmen, adding that drafting such a piece of legislation requires "a sophisticated type of judicial system."

According to the GHRA, while the epidemic in most Caribbean territories is at a stage where it is concentrated in specific groups, the prevalence in Guyana is indicating that the country is confronting a generalised HIV epidemic.

The GHRA was also instrumental in facilitating and coordinating the national AIDS policy which was passed by Parliament in 1998. Apart from clarifying the medical and ethical considerations for example with respect to confidentiality and testing, the Policy also has a rights-based approach to areas such as the school, the working environment, housing, social benefits and transportation.

For example Article 2.3.11 states: "There must be no reduction or restriction of the social and working environment of any individual who is HIV positive." and also Article 2.3.12: "There must be no discrimination against HIV positive persons in terms of admission, transfer and attendance at educational and/or other training facilities."

AIDS threat message has not yet sunk in
- PAHO Representative

A clarion call has been issued for a swift inter-sectoral response to HIV-AIDS in Guyana, because the epidemic is generalised, and is still growing.

The message has not sunk in, PAHO/WHO Representative, Dr Bernadette Theodore-Gandi feels. She added that because persons are not testing, and given Guyana's difficult terrain, up-to-date statistics cannot be had. Nevertheless, she said national prevalence studies are being conducted on special populations, such as pregnant women and sex-workers.

"It is mostly the young people who are infected. Young people are indispensable... The message has not sunk in about the impact of the disease", she said.

Dr Gandi said "all of the racial groups are affected, but the problem with this is that some are not as open as others. There is widespread infection among the Indian population now, and still this is not being acknowledged. This is because of the persistent fear of being recognised, being in denial and stigmatisation. Even those at risk who should confirm whether they are positive or negative are stigmatised."

She said the strategy of employing Regional AIDS Committees would be best for tackling the disease because it would impact at a community level but this method is very expensive in Guyana because of the difficult terrain. Dr Gandi stressed that local governments need to take a proactive approach, and that it is not a Ministry of Health matter.

"This is one time we need to forget race, creed or religion and work with the Ministry of Health for the survival of the community," she stated.

Dr Gandi said she looks at the death announcements on TV, and these indicate the depth to which the disease has spread. She called for a policy of protection.

She said even though information is widely available on the issue, bringing about change boils down to the individual, and this is challenging. It is a cultural problem, and "sex is still a macho thing here". But what of the socio-economic pressures? Dr Gandi agreed that these force individuals to make choices even against their will. But she emphasised the need for inter-sectoral cooperation among the Government Ministries and Departments in helping to combat the spread of the disease. She noted that to a large extent there is still a great dependence on the Ministry of Health and non-governmental organisations (NGOs). Giving her impressions of the "Men Make a Difference" UNAIDS Theme for the year in Guyana's context, Dr Gandi said men need to start examining their roles and learn to take responsibility. They also need to encourage their colleagues to do the right thing, she added.

She welcomed the recent entertainers' workshop to highlight the issue and its outcome. At a recent workshop, one entertainer admitted being infected with the disease, and entertainers then pledged to make a difference through their music by inserting messages to youths.

She spoke of the conflict of whether men should pay for condoms or not. "When they're given out free, they're perceived as not good or nicely packaged. But when they pay for them, then they're perceived as good, although most condoms are free of charge.

PAHO/WHO would like to see more get involved in bringing the issue of HIV/AIDS to the fore, and according to Dr Gandi, highlighting persons living with the disease can create the greatest impact in helping to bring about change in attitudes and lifestyles. She said this is very much present in the Trinidad media. "Take a case, give the facts and all the components... but give the human side. It is not the name of the person that matter but the reality of AIDS" added Dr. Gandi.

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